Persistence and reconstruction in the health sectorLocal policy to combat aids
Aids was a disruptive factor in the health sector. According to a common hypothesis, this disruption gave birth to a new public health policy in France. According to another hypothesis, which this article stands up for, the reconstruction observed gives more weight to the public hospital within the French health system and to the individual curative model on which it is based. To back this hypothesis, local policies to combat aids were studied in six different departments in relation to the institutional matrix in which they fall. An institutional matrix consists of an institutional arrangement within a territory and belonging to a societal sector. In the case of aids this matrix is composed of three poles : health, political and medical-social welfare. Depending on its degree of integration, this matrix defines the form and the content of actions undertaken, both in the prevention and in the taking care of patients. In most cases it manages to reabsorb the disputes resulting from taking medical care of patients and the monopoly of the legitimate expertise of hospital practitioners, by imposing on the different actors involved in combating aids the obligation to adopt institutionalized rules which reproduce dominant legitimate forms in the health sector. The public hospital is all the stronger after this trial, but its modalities of intervention evolve, especially towards prevention and a move towards opening its environment – whereas approaches from, for example, a community model remain marginal or isolated without the capacity to deeply transform the French health sector.